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Peer-reviewedCC BY-NC-ND 4.0Journal of clinical gastroenterology

The Trajectory of Gastrointestinal Symptom Experience Following Fecal Microbiota Transplant for Recurrent Clostridioides Difficile Infection

  • Hijab Zehra1
  • Nataliia Kuchma2
  • Annie W. Lin3
  • Glen Morris3
  • Olivia Solano3
  • Sharon Lopez2
  • Amanda J. Kabage2
  • Byron P. Vaughn2
  • Alexa Weingarden2
  • Monika Fischer4
  • Alexander Khoruts2
  • Levi Teigen1,2
4 affiliations
  1. 1Department of Food Science and Nutrition, University of Minnesota, St. Paul
  2. 2Department of Medicine, Division of Gastroenterology, University of Minnesota, Minneapolis
  3. 3The Hormel Research Institute, Austin, MN
  4. 4Indiana University School of Medicine, Indiana University, Indianapolis, IN.
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Abstract

Introduction:: Recurrent Clostridioides difficile infection (rCDI) increases the risk of persistent gastrointestinal symptoms after treatment. Although fecal microbiota transplantation (FMT) effectively prevents CDI recurrence after antibiotics, the trajectory of gastrointestinal symptom severity remains poorly characterized.

Methods:: We tracked gastrointestinal symptom severity in a prospective, multicenter cohort study of adults with rCDI after treatment with standardized FMT products. Patients who experienced a CDI recurrence during the follow-up period were excluded. The IBS Symptom Severity Scale (IBS-SSS) was used as a measure of symptom severity, not as a diagnostic tool. Patients completed the IBS-SSS at the time of FMT, 1-week, 1-month, and 3-months post-FMT. The primary outcome was the change in IBS-SSS score after treatment. Subgroup analyses were conducted among patients with baseline IBS-SSS ≥ 175 (moderate/severe symptom severity) and < 175 (none/mild symptom severity). Linear mixed-effects models were used to evaluate longitudinal changes and identify clinical predictors of IBS-SSS scores.

Results:: Among 107 patients included, median IBS-SSS scores decreased from 170 (range: 0 to 440) at baseline to 76 (range: 0 to 390) at week 1 and 54 (0 to 445) at month 3 (P < 0.001). In those with baseline IBS-SSS ≥ 175 (n = 51), 64% had none or mild symptom severity at month 3. In those with baseline IBS-SSS < 175 (n = 53), symptom severity was observed to remain as none or mild at month 3 in all but one patient.

Conclusion:: FMT administered for prevention of rCDI was followed by a rapid (1 wk) and sustained (3 mo) reduction in gastrointestinal symptom scores in patients who did not develop CDI recurrence. These data help characterize the expected early post-FMT symptom trajectory, providing foundational evidence to better inform patient expectations and future interventions for persistent symptoms.

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Cite

BibTeXRIS
BibTeX
@article{zehra2026trajectory,
  title = {{The Trajectory of Gastrointestinal Symptom Experience Following Fecal Microbiota Transplant for Recurrent Clostridioides Difficile Infection}},
  author = {Hijab Zehra and Nataliia Kuchma and Annie W. Lin and Glen Morris and Olivia Solano and Sharon Lopez and Amanda J. Kabage and Byron P. Vaughn and Alexa Weingarden and Monika Fischer and Alexander Khoruts and Levi Teigen},
  journal = {Journal of clinical gastroenterology},
  year = {2026},
  month = oct,
  doi = {10.1097/mcg.0000000000002424},
  url = {https://doi.org/10.1097/mcg.0000000000002424},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - The Trajectory of Gastrointestinal Symptom Experience Following Fecal Microbiota Transplant for Recurrent Clostridioides Difficile Infection
AU  - Hijab Zehra
AU  - Nataliia Kuchma
AU  - Annie W. Lin
AU  - Glen Morris
AU  - Olivia Solano
AU  - Sharon Lopez
AU  - Amanda J. Kabage
AU  - Byron P. Vaughn
AU  - Alexa Weingarden
AU  - Monika Fischer
AU  - Alexander Khoruts
AU  - Levi Teigen
PY  - 2026
DA  - 2026/10/16
JO  - Journal of clinical gastroenterology
DO  - 10.1097/mcg.0000000000002424
UR  - https://doi.org/10.1097/mcg.0000000000002424
AB  - Introduction:: Recurrent Clostridioides difficile infection (rCDI) increases the risk of persistent gastrointestinal symptoms after treatment. Although fecal microbiota transplantation (FMT) effectively prevents CDI recurrence after antibiotics, the trajectory of gastrointestinal symptom severity remains poorly characterized.  Methods:: We tracked gastrointestinal symptom severity in a prospective, multicenter cohort study of adults with rCDI after treatment with standardized FMT products. Patients who experienced a CDI recurrence during the follow-up period were excluded. The IBS Symptom Severity Scale (IBS-SSS) was used as a measure of symptom severity, not as a diagnostic tool. Patients completed the IBS-SSS at the time of FMT, 1-week, 1-month, and 3-months post-FMT. The primary outcome was the change in IBS-SSS score after treatment. Subgroup analyses were conducted among patients with baseline IBS-SSS ≥ 175 (moderate/severe symptom severity) and < 175 (none/mild symptom severity). Linear mixed-effects models were used to evaluate longitudinal changes and identify clinical predictors of IBS-SSS scores.  Results:: Among 107 patients included, median IBS-SSS scores decreased from 170 (range: 0 to 440) at baseline to 76 (range: 0 to 390) at week 1 and 54 (0 to 445) at month 3 (P < 0.001). In those with baseline IBS-SSS ≥ 175 (n = 51), 64% had none or mild symptom severity at month 3. In those with baseline IBS-SSS < 175 (n = 53), symptom severity was observed to remain as none or mild at month 3 in all but one patient.  Conclusion:: FMT administered for prevention of rCDI was followed by a rapid (1 wk) and sustained (3 mo) reduction in gastrointestinal symptom scores in patients who did not develop CDI recurrence. These data help characterize the expected early post-FMT symptom trajectory, providing foundational evidence to better inform patient expectations and future interventions for persistent symptoms.
SN  - 0192-0790
SN  - 1539-2031
ER  -